Protocol for a randomised controlled trial of a decision aid for the management of pain in labour and childbirth [ISRCTN52287533]

BACKGROUND: Women report fear of pain in childbirth and often lack complete information on analgesic options prior to labour. Preferences for pain relief should be discussed before labour begins. A woman's antepartum decision to use pain relief is likely influenced by her cultural background, friends, family, the media, literature and her antenatal caregivers. Pregnant women report that information about analgesia was most commonly derived from hearsay and least commonly from health professionals. Decision aids are emerging as a promising tool to assist practitioners and their patients in evidence-based decision making. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. METHODS/DESIGN: We aim to evaluate the effectiveness of a Pain Relief for Labour decision aid, with and without an audio-component, compared to a pamphlet in a three-arm randomised controlled trial. Approximately 600 women expecting their first baby and planning a vaginal birth will be recruited for the trial. The primary outcomes of the study are decisional conflict (uncertainty about a course of action), knowledge, anxiety and satisfaction with decision-making and will be assessed using self-administered questionnaires. The decision aid is not intended to influence the type of analgesia used during labour, however we will monitor health service utilisation rates and maternal and perinatal outcomes. This study is funded by a competitive peer-reviewed grant from the Australian National Health and Medical Research Council (No. 253635). DISCUSSION: The Pain Relief for Labour decision aid was developed using the Ottawa Decision Support Framework and systematic reviews of the evidence about the benefits and risks of the non-pharmacological and pharmacological methods of pain relief for labour. It comprises a workbook and worksheet and has been developed in two forms – with and without an audio-component (compact disc). The format allows women to take the decision aid home and discuss it with their partner

The influence of maternal socio-economic status on infant feeding practices and anthropometry of HIV exposed infants

The purpose of this quantitative, descriptive, cross sectional survey was to determine whether maternal socio-economic status has any influence on infant feeding practices and infant anthropometry of HIV exposed infants. Information was collected from 125 mother-infant pairs who presented at the health clinic with infants aged between six weeks to six months. Nearly twice as many infants (49.6%) of the single mothers were underweight as compared to infants (19.8%) whose parents were married. Similarly, twice as many infants (50%) were underweight if their mothers walked to the health facility compared to 23.8% of infants’ whose mothers’ used taxis. Education and employment status of mothers appear to prevent infants from becoming underweight as twice as many infants (45%) were underweight when their mothers did not complete secondary school, compared to 23.3% of infants whose mothers did complete secondary schooling. Nearly fourfold more infants (59.5%) were underweight if their mothers were unemployed compared to those infants (14.9%) whose mothers were employed. Housing, the presence of a flush toilet or running tap water in the house did not improve the body mass index of infants. A total of 57.4% of infants whose mothers resided in brick houses, 71.9% of infants whose mothers had access to flush toilets and 57.5% who had running tap water in the house were still underweight. Infants whose mothers lived in houses with less than two rooms or where 3-4 people occupy the house had a higher risk of being underweight (54.6% and 40.5%, respectively). Sub-optimal feeding patterns are still present despite the availability of free formula feeds.Keywords: Socio-economic status, infant feeding, anthropometry